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201405 Merchant Application SBS Pass Through <br />CONFIDENTIAL <br />VISA/MC/DISCOVER <br />00000 <br />. <br />Pass through pricing: % DISCOUNT' on SALES + g 0.00000 per item on gross items (SALES plus Credits) <br />Most <br />VisaRewards, Visa Signature, Visa Premium, MasterCard World, MasterCard Enhanced, Most rCard Premium and Discover Premium cards will be assessed an <br />additional to the applicable rate tier. Please review the Rate Descriptions online at or contact TMS at 800.228.2443 for <br />additional information on which interchange programs qualify. <br />- Merchant Setup $ 0.00 per MID <br />Authorizations $ 0.0350 per V/MC/Disc /AMEX OnePoint Ai th <br />"or, <br />Excessive Electronic Authorizations $ per V/MC/Disc Auth over 100% of <br />Monthly Maintenance $ 0.00 per MID <br />SALES & per AMEX OnePoint Aulh <br />Minimum Discount Billing $ per montleMID <br />Non V/MC/Dise/AMEX OnePoint $0.0350 each <br />Authorizations <br />Chargebacks $ 5.00 each <br />Voice Authorizations $ 0.6500 each <br />Retrievals $ 5.00 each <br />Voice AVS $ 1.99 each <br />Batch Capture $ 0.00 each <br />Paper Statement ❑ Yes ❑ No $9.95 per month/MID <br />Insufficient Funds Fee $35 per unsuccessful debit of <br />Wireless Monthly $ per device <br />DESIGNATED Account <br />Wireless Set Up $ per device <br />Annual Seasonal $ per MID <br />OTHER $ <br />Regulatory and Compliance $ 1.00 per month /MID <br />OTHER $ <br />ATM/DEBrr ❑ Yes ❑No PCI VALIDATION FEE <br />Setup$ per MID PCI Validation Fee$ 45.00 peryear/MiDOR $ 3.75 permonth/MID <br />Transactions $ each <br />Monthly per MID $ PCI Non - validation Fee: $ per month/MID if MERCHANT is not validated for compliance with <br />TMS's vendor, beginning 75 days after signing. <br />Network Fees Pass thru <br />ACCOUNT <br />Account Closure Fee: If the AGREEMENT is terminated early during the INITIAL TERM or any RENEWAL TERM for any reason other than set out in paragraph <br />5.1, 5.2A, or 5.2.B, then MERCHANT agrees to pay TMS an account closure fee ( "ACCOUNT CLOSURE FEE ") in accordance with the following: $399 per MID <br />during the first 12 months of the INITIAL TERM; $299 per MID during the second 12 months of the INITIAL TERM; $199 per MID during the third 12 months of <br />the INITIAL TERM; $149 per MID during any RENEWAL TERM. MERCHANT agrees that the ACCOUNT CLOSURE FEE shall also be due to TMS in accord- <br />ance with this schedule if MERCHANT discontinues submitting SALES for processing during the INITIAL TERM or any RENEWAL TERM of the AGREEMENT. <br />MERCHANT agrees that this fee is a not a penalty, but rather a reasonable estimation of the actual damages TMS would suffer if TMS were to fail to receive the <br />processing business for the then current term. Paragraph references and capitalized terms not defined in this paragraph are defined in the attached Terms and Condi- <br />tions. Pursuant to Section 4.1 of the Terms and Conditions the INITIAL TERM shall be for 3 years, <br />TSYS MERCHANT TNSTGHTS'M ESSENTIALS <br />re d. r.,.e •�I A a I IirJD rah if not celled dtlr' v "'°r'^°riod. f-' <br />COMPROMISE CARD <br />CCAP Fee (PCI Validated): $ 1.95 per month/MID, if MERCHANT is validated for PCI Compliance with TMS's vendor. <br />CCAP Fee (PCI Non - Validated) : $ 34_95 per month /MID, if MERCHANT is not validated for PCI Compliance with TMS's vendor, beginning 75 days after <br />signing. This program is not being offered by Bank. Bank has no respmsihiftty or liability under this program, <br />CARD COMPROMISE ASSISTANCE PLAN (CCAP) OPT OUT <br />MERCHANT may only opt out if MERCHANT validates PCI Compliance with TMS vendor within 75 days of signing. If at anytime MERCHANT is not validated <br />for compliance, MERCHANT will be automatically enrolled in CCAP until such time that MERCHANT restores validation, at which point MERCHANT will again <br />be opted out MERCHANT declines to participate in the Card Compromise Assistance Plan ( "CCAP "). MERCHANT understands that tinder the terms of the <br />AGREEMENT, MERCHANT is responsible for all expenses, fines, assessments, and penalties that arise in the event that a data breach is suspected or occurs at one <br />or more of MERCHANT's locations. Further, MERCHANT understands and agrees that CCAP assistance will not be available to help pay any of the above men- <br />tioned expenses, fines, assessments, or penalties in die event of a suspected or actual data breach at one or more of MERCHANT's locations. MERCHANT acknowl- <br />edges that despite opting out of CCAP, MERCHANT will still be assessed a PCI Validation Fee. This program is not being offered by BANK. BANK has no respon- <br />sibility or liability under this program. <br />Merchant Name: vJ <br />Authorized Signa e. <br />//,J <br />Titre: <br />Date: 7/14/14 <br />AM <br />Diseount is a FEE charged as a percentage of gross SALES sulmsitmd by MERCHANT, which generally includes "Processing," "Anlhon rations; "'Assessments," and `Lnxmbangc.' <br />ATTES'P <br />Merchant Initials: X <br />CLERK pT. "at Soolu�pps, LLC is a registered agent of First National Bank of Omaha, 1620 odge Street, Omaha, HE 68197 s <br />V 2c,14 <br />